Organization
EMERSON PHARMACY INC
Active
Other names
LOYOLA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NIMA RODEFSHALOM (PRESIDENT)
(310) 670-3834
Entity
Organization
Contact information
Practice address
8610 S SEPULVEDA BLVD STE 108, LOS ANGELES, CA 90045-4009
(310) 670-3834
(310) 670-4921
Mailing address
1702 S ROBERTSON BLVD # 152, LOS ANGELES, CA 90035-4316
(310) 670-3834
(310) 670-4921
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY53692
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992617
PK
—
05
—
PHA406050
—
CA
Enumeration date
12/08/2006
Last updated
10/12/2016
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